Abstract Title

Full Mouth Oral Rehabilitation of a Partially Edentulous GERD Patient Utilizing Long Span Monolithic Zirconia Bridges—A Case Presentation

Lead Author Affiliation

Doctor of Dental Surgery

Lead Author Status

DDS Year 3

Expected Graduation Date

2019

Presentation Category

Restorative (Direct/Indirect)

Introduction/Context/Diagnosis

Historically, three and four unit fixed partial dentures were and still commonly are fabricated with a metal framework and subsequently layered with porcelain. This combined the strength of metal for spanning edentulous gaps of one or two teeth while also utilizing the aesthetics veneered porcelain has to offer. This proved to be a successful treatment modality for many decades, but it is not without problems. Veneered porcelain can look fantastic, but the interface between the porcelain and metal is relatively weak and prone to fracture, leading to partial failure of the prosthesis and a potentially dissatisfied patient. Perhaps there is a better way. With rapid increases in technology in recent years--especially material science--can we replace these dated restorations with something that overcomes the old problems of chipped porcelain and can we do it with a long spanned four unit bridge? Even more, is the long term prognosis more favorable with an all-ceramic option? What considerations should we make when treatment planning for patients with bruxism, severe GERD, and subsequent gross loss of tooth structure?

Methods/Treatment Plan

After significant research, discussion with numerous faculty, clinical and radiographic examination, and a carefully designed functional wax up of both arches, we initiated treatment of a full mouth reconstruction designed to restore lost teeth, tooth structure, and deliver a highly functional and aesthetic result. The treatment plan consists of creating a plan to manage his periodontal disease and a high caries risk, followed by caries control and four posterior monolithic zirconia bridges--two four-unit bridges and two three-unit bridges (to be made in the order of #2-5; #28-31; #20-18; and #12-14). After stabilizing the occlusion, the remaining pre-molars would be crowned in either monolithic zirconia or layered zirconia. After the pre-molars, the maxillary anterior six teeth would be crowned followed by the mandibular six. All of this will be done in stages and without altering VDO. Once all this is complete, an occlusal guard will be fabricated--a non-negotiable part of this treatment plan.

Results/Outcome

At the time of writing, two four-unit bridges have been completed and successfully delivered, providing a stable occlusion on the right side of my patient's dentition. #2-5 Monolithic Zirconia Bridge was fabricated from a traditional PVS impression utilizing a self-designed functional wax-up as a guide, while the opposing #28-31 Monolithic Zirconia Bridge was fabricated from a digital scanned impression to match the upper bridge in aesthetics and occlusion.

Significance/Conclusions

Moving away from traditional PFM bridges and toward monolithic zirconia bridges in the posterior dentition may eliminate the complications of veneer fracture, resulting in a more aesthetic outcome and prove to have an equal if not better long term favorable prognosis. Additionally, these prostheses can be used successfully in long spanned four-unit bridges but do require specific parameters that must be met to withstand posterior occlusal forces, especially in bruxers. Additionally, GERD patients typically exhibit certain key features, one of which is no change in VDO, and these must be considered when designing the final treatment plan. Continued research into long spanned Monolithic Zirconia bridges is important to keep pushing the technological advances we see in dentistry in the goal of being able to provide better and longer lasting care for our patients.

Comments/Acknowledgements

Thank you to Dr. Gupta, Dr. Orson, Dr. Tran, and Donnie for believing in me and helping me through this complicated restorative treatment plan.

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Full Mouth Oral Rehabilitation of a Partially Edentulous GERD Patient Utilizing Long Span Monolithic Zirconia Bridges—A Case Presentation

Historically, three and four unit fixed partial dentures were and still commonly are fabricated with a metal framework and subsequently layered with porcelain. This combined the strength of metal for spanning edentulous gaps of one or two teeth while also utilizing the aesthetics veneered porcelain has to offer. This proved to be a successful treatment modality for many decades, but it is not without problems. Veneered porcelain can look fantastic, but the interface between the porcelain and metal is relatively weak and prone to fracture, leading to partial failure of the prosthesis and a potentially dissatisfied patient. Perhaps there is a better way. With rapid increases in technology in recent years--especially material science--can we replace these dated restorations with something that overcomes the old problems of chipped porcelain and can we do it with a long spanned four unit bridge? Even more, is the long term prognosis more favorable with an all-ceramic option? What considerations should we make when treatment planning for patients with bruxism, severe GERD, and subsequent gross loss of tooth structure?